The Longest Day

Last Wednesday was pretty rough. This was not a typical day for me. Here were my appointments:

- Puppy with vaginal discharge after her spay last week (no, I didn't perform it) whose owner was freaking out. Looked like puppy vaginitis.
- Newly adopted rescue dog, just preventive care. Fairly straightforward.
- Eye recheck for a dog with red irritated eyes, improved but not resolved.
- Rechecks for kittens who had upper respiratory infections, now resolved.
- Dog with recurring urinary tract infections, unable to get urine since she went just before her appointment.
- Dog with horrible skin issues (a breed who is notorious for severe allergies) whose owner repeatedly declines workup, changes the dog's diet frequently without consulting us, and sometimes forgets flea preventative then wonders why the dog's skin is always messed up. Repeat my speech on dog allergies for the 3rd? 4th? 100th? time with that client.
- Dog who needs vaccines but the owners have no idea what he needs or when he last had vaccines. They sat there with their arms folded across their chest as though I was supposed to use my magic psychic powers to figure that out.
- Ancient dog with 7-8 major problems and an owner with no money who wants to chat about everything that *could* be done for the dog but that they won't do for the dog. This appointment set me behind schedule by about 15-20 minutes.
- Dog ear infection recheck. I'm only allocated 20 minutes because it's a recheck appointment but hey doc, the dog is limping now too, could you check that out in less time than you usually have for a new problem?
- Itchy cat recheck. Owner just changed to limited ingredient diet and has been keeping all cats on monthly flea preventative. Say a silent thanks for this client because they are awesome.
- Recheck of cat being pet sitted by owner's EXTREMELY high-strung and rude daughter. Ugh.
- Wellness exam for a grumpy cat whose owner is pretty awesome.
- 30 minutes before closing emergency hit by car stray kitten who is 95% dead. Have to help it the rest of the way.

I came home, had a beer, and cried.

Speaking of emergency ...

I found this great blog entry today containing tips for dealing with veterinary emergencies (as an owner/client).

Same situation, VERY different response

Once in a while you have a complication with a patient under anesthesia. I have now twice seen instances where a cat, while under anesthesia for a dental, developed a cardiac arrhythmia. (For those who care, they started getting individual VPCs and then developed into runs of them.)

As you may imagine, abnormal heart rhythms are a pretty big concern for us because they sometimes lead to death.

In both cases we aborted the dental and woke the patient up from anesthesia. Fortunately in both cases it was during the scaling (cleaning) part of the procedure and not during any extractions (surgery).

Case #1 at the corporate practice - I talk with the owner. Owner's response includes questions such as the following:
"So we used up the dental on my plan and I can't have it done until next year now?"
"Why couldn't you just finish?"
"How much would it cost to see a cardiologist?" (Ok, this one is a fair question but it illustrates the mindset of the owner - greater concern for money than for their cat - or at least that's the way it appeared!)
I had to bite my tongue from saying to this owner "So you wanted your cat's teeth cleaned even though he could be DEAD with clean teeth?!?!?!"

Case #2 at my current practice - my colleague talks with the owner (it wasn't my case this time.)
Owner's response:
"Thank goodness he's okay!"
"What should we do next to find out why this happened?"

Which owner would you rather work with?

Grim

This week was rough. I'd estimate that 25% of my appointments ended up with the clients crying - either because I euthanized their pet or I gave them a cancer diagnosis. That's a pretty high percentage when you're not an emergency doctor!

I've also got my first client who I suspect is mentally ill and it has been exhausting for everyone who has dealt with them. Fortunately Dr. Boss is calling them later today and we'll see what comes of that.

Thankfully I have the rest of the weekend to unwind. Think I might have a beer!

Flamed

I received my first piece of hate mail today.

It was a patient I saw 3 weeks ago - new client, new patient. Presenting complaint - intermittent gagging every few months. Talked extensively with the client about history, did my physical exam (which was unremarkable), then talked some more with the client about possible causes. Discussed x-rays to help with diagnosis. Recommended that if it happens again, since it wasn't reproducible in the exam room, that they try to get video of it as that can be helpful.

According to this letter I was extremely rude and unprofessional, the tech knew more than me, all I did was run my hands over the dog, and I also apparently cut off the client and said "I think we're done here." (I've never used that phrase in my entire life.) The letter was also apparently sent to the president of the company.

WTF?

Oh, and that particular office visit was FREE, by the way (pretty much all new clients/new pets are free for their first visit), so I'm not sure what this person stands to gain by complaining. I'm also not sure why it was written 3 weeks after the fact. Did they really spend this whole time stewing over imaginary things?

Ugh. I just have to remember that this is one out of hundreds of clients and thousands of patients I've dealt with.